Nov 162015
 

This week let’s take a break from genetics and ask: “Among transgender people seeking medical treatment, how many want what treatment? Among those who are not seeking out the traditional transition, what are their reasons?” As you might have guessed, a paper from the Netherlands was just online published ahead of print addressing these very questions.

360 people seeking treatment at a specific clinic in the Netherlands were surveyed; 233 (64.7%) of them were assigned male at birth (AMAB; mostly trans feminine) and 127 (35.3%) were assigned female at birth (AFAB; mostly trans masculine). Because this was a survey specifically asking about trans people who may fall outside the gender binary, I’ll stick to the AFAB/AMAB terminology.

The researchers also defined “full” and “partial” transition. For the purposes of this study, “full” transition was either:

  • Antiandrogens + estrogen + orchiectomy + vaginoplasty, for AMAB people
  • Androgens + mastectomy + hysterectomy/oophorectomy + phalloplasty or metoidioplasty, for AFAB people

Variations on these were considered “partial” transition, even if they included more surgeries (such as facial feminization surgery or breast augmentation). By using the terms “full” and “partial”, neither the researchers nor I are trying to imply that one form of transition is any better, desirable, or more “complete” than any other. It’s a historical term, and used here only as a label for one set of treatments that have been considered a “standard” treatment.

So — what did the 360 people want? 10 weren’t sure yet (2.8%). Overall, 253 (70%) wanted “full” treatment. and 97 (27%) wanted “partial” treatment. Of the 97 who wanted a “partial” treatment, 47 cited surgical risks and concerns about the ultimate result, 19 had no genital dysphoria and felt genital surgery wasn’t important for them, 5 felt they were too old, 4 had a non-binary gender identity, 1 was afraid of social rejection, 1 wanted to remain fertile, 1 wanted to go outside the country for surgery, and the others declined to answer.

If you look at the data differently, AFAB and AMAB people wanted different things. Among the 225 AMAB people who knew what they wanted, 180 (77%) wanted “full” treatment. Only 45 (19%) wanted a different treatment. 12 wanted hormones only, another 12 wanted hormones and breast augmentation, and another 10 wanted hormones and breast augmentation and facial feminization surgery.

AFAB people were less likely to want “full” treatment — only 73 of 125 (57%) wanted “full” treatment. Of those, 35 wanted phalloplasty, 12 wanted metoidioplasty, and 26 were uncertain. 52 of 125 (41%) wanted “partial” treatment, with the majority (31) wanting androgens, mastectomy and hysterectomy and 18 wanting androgens and mastectomy without hysterectomy.

That’s quite a difference between AMAB and AFAB people — 77% vs 57% wanting “full” treatment. When the reasons were compared, AFAB people were most likely to be concerned about the risks and results of surgery. AMAB people, on the other hands, were more likely to report feeling that genital surgery was unnecessary.

Of course, this was just one survey within one culture. However, it’s interesting food for thought and gives one set of ballpark figures for who wants what treatment.

Want to read the study for yourself? The abstract is publicly available!

Jan 042015
 

8787343055_a2a6eb06bf_mIt’s a new year here at Open Minded Health. I hope you all had a safe, fabulous, and fun new years celebration. Here at OMH it’s time for the yearly questions and answers post.

For the unfamiliar — once a year I take a deep look at all the search queries that bring people here. Often, they’re questions that I didn’t completely answer or that need answering. So in case anyone else has these questions — there are answers here now that Google can find. The questions are anonymous and I reword them to further anonymize them.

This year is all questions about transgender health issues. There’s been a lot published and a lot in the news about trans health issues lately. This next year I’ll try to find other articles to post about too, though. 🙂

Questions!

What are the healthier estrogens that a transgender woman can take?

In order from least risk to most risk: estrogen patch, estrogen injection sublingual/oral estradiol, oral ethinyl estradiol, oral premarin.

But note that that’s an incomplete picture. The estrogen patch isn’t the best for initial transition and is very expensive. Injectable estrogen means sticking yourself with a needle every 1-2 weeks and needing a special letter to fly with medications. By far the cheapest of these options is oral estradiol.

Ethinyl estradiol is the form of estrogen used in birth control. Premarin is conjugated equine estrogens, meaning they’re the estrogens from a pregnant horse. Neither should be the first choice for transition. They’re both higher risk than estradiol.

For transgender women, how long does it take to see the benefits of taking spironolactone?

The rule of thumb is 3 months before changes on hormone therapy.

Where is the incision placed in an orchiectomy for transgender women?

That depends on the surgeon. But I’m know you can find images and personal stories on /r/transhealth and transbucket.

Does a trans man have to stop taking hormones to give birth?

Yes. Trans men and others who can become pregnant who are taking testosterone must stop testosterone treatment before becoming pregnant. Testosterone can cross the placenta and cause serious problems for the fetus. Once the child is delivered and no longer breast feeding testosterone can be resumed.

Once you’re on female hormones, how long does it take to get hair down to your shoulders?

My understanding is that the speed that hair grows doesn’t change. It grows at roughly 1/2 an inch a month. Expect growing it out to shoulder length to take 2-3 years.

As a trans woman on estrogen, are there foods I should avoid?

If you’re on estrogen only, there are no foods you should avoid. Instead eat a healthy varied diet.

If you’re on spironolactone you may need to avoid foods that are high in potassium. Potato skins, sweet potatoes, bananas, and sports supplements are foods you may need to limit or avoid. Ask your physician if you need to avoid these foods.

Is there a special diet that can help me transition?

In general, no. Any effect that food may have is, in general, too subtle to make a difference. The possible exception is foods that are very high in phytoestrogens — like soy. Phytoestrogens are chemicals in plants that act a little like estrogen in the body. There are a few case reports in the medical literature of people developing breasts when they eat a lot (and I do mean a lot) of soy. But they’re unusual. Ask your physician before you make radical changes in your diet. In general — just eat a healthy, varied diet.

I’m a trans guy taking testosterone and having shortness of breath. Do I need to worry?

See a physician as soon as you can. Shortness of breath may be a sign of something serious. Taking testosterone raises your risk for polycythemia (too many red blood cells in the blood), which can manifest as shortness of breath.

How often do trans women get injections of estrogen?

Most women have their injection every week to two weeks.

Can I still masturbate while I’m on estrogen?

Yes. Many trans women have difficulty getting or maintaining an erection though.

Can I get a vaginoplasty before coming out as transgender or transitioning?

Generally speaking, no. Surgeons follow the WPATH standards of care which require hormone therapy and letters of recommendation from physicians and therapists before vaginoplasty.

Are there risks to having deep penetrative sex if you’re a trans woman?

I’m assuming you’re referring to vaginal sex post-vaginoplasty. The vagina after a vaginoplasty is not as stretchy or as sturdy as most cis vaginas. It’s possible to cause some tearing if the sex is vigorous or if there are sharp edges (e.g., a piercing or rough fingernails).

Things you can do that might help prevent injury: Make sure you’re well healed after surgery. Dilate regularly as recommended by your surgeon. Use lots of lubrication, and try to go gently at first. Topical estrogen creams may also be helpful for lubrication and flexibility.

Is it safe to be on trans hormone therapy if you have a high red blood count?

Depends. If you’re a trans man looking for testosterone, you may need treatment first to control the high red blood cell count. Testosterone encourages the body to make more red blood cells, which would make the problem worse.

What kinds of injection-free hormone therapy are available to trans men?

Topical testosterone is available for trans men. It’s a slower transition and it’s expensive, but it exists and it works. Oral testosterone should never be used because of the risk of liver damage.

What can cause cloudy vision in trans women on hormone therapy?

Seek medical care. It could be unrelated, but changes to vision are not a good sign.

~~

And that’s it for this year! Next week we’ll be back to normal posts. 🙂

Jun 032014
 

6763959_10420a4b6a_mThe biggest news for May of 2014 is really that Medicare lifted the blanket ban on covering genital surgeries for trans people. The National Center for Transgender Equality has a good summary (PDF) of what the decision actually means. If you’re trans and interested in surgery and are a Medicare recipient, I recommend calling the physician who’s prescribing your hormones and consulting with them about next steps. The news was covered in multiple outlets including the NY Times and CNN.

The other piece of news I spotted that is not getting as much traction as I’d like is this: Urine is NOT sterile! For a long time it’s been believed that urine produced by healthy people is sterile – at least until it passes through the urethra. Turns out not to be the case. Something to keep in mind if you have contact with urine. Source

Interested in the other news? Read on!

  • Work continues on the possibility of three-parent babies. While much of the research and reporting talks about preventing mitochondrial diseases, I still think it opens a wonderful door for three-parent poly households. The latest news is fairly political, but supportive.
  • Another study out of Europe indicates that transgender hormone therapy is safe. This was a 1-year study of both men and women, just over 100 people total No deaths or serious adverse reactions were reported. Highly recommend you skim the abstract for yourself! For US readers, please do note though that the hormones used in the study were different formulations than those used in the US. Source.
  • A published case study reminds us that not all “odd” physical things during medical transition are related to transition. This was a case of a trans man who had undiagnosed acromegaly from a benign brain tumor. Eek! He was correctly diagnosed and treated, thankfully. Source.
  • A Swedish review of transgender-related records found a transition regret rate of 2.2%. Other prevalence data, including the usual male:female ratios, are included. Source.
  • A study of gay men found that they have worse outcomes from prostate cancer treatments than straight men. Source.
Nov 052013
 

News for the month of October - CC BY 2.0 - flickr user  cygnus921It’s that time of month again! No, not when we try to take over the world… it’s time for the monthly news! In no particular order, then, here we go:

  • Analysis of herbal supplements finds that many are contaminated with species not listed in the ingredients label. Herbs are typically classified as supplements in the United States, and are not regulated by the Food and Drug Administration the way medications are. The FDA website has more on the regulation of herbsSource.
  • One dose of Gardasil may be enough to protect against cervical cancer (but please remember to follow your physician’s instructions about vaccines!). Source. At the same time, the HPV vaccines may be less effective for people of African heritage than for people of European heritage. Source.
  • More evidence that monthly changes in sex hormones in cisgender women are associated with changes in sex drive. Source.
  • Germany’s “indeterminate” birth certificate sex designation law comes into effect. The “Indeterminate” marker is, from what I understand, intended to denote intersex babies, not transgender people. The BBC did a fairly good summary of some community reactions. Source.
  • Low prolactin levels in cisgender men as they age has been correlated with reduced sexuality and sexual functioning. Low prolactin levels were also correlated with general unwellness. Prolactin is a hormone most well known for being involved with lactation in breast-feeding parents, but has other effects too. Source.
  • A new study examining sexual satisfaction in women with complete androgen insensitivity syndrome (CAIS) or Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH Syndrome, aka Müllerian agenesis). Women with CAIS reported less sexual satisfaction and confidence than women with MRKH Syndrome, who mostly reported being satisfied with their sex life. The abstract on this paper is fairly scarce so I’ll try to grab a copy for better examination. Source.
  • A study in Ontario, Canada found that 1/3 of trans people needed emergency medical services in 2012, but only 71% were actually able to receive it. 1/4th of those in the survey reported avoiding the emergency room because they are trans, and just over half needed to educate their provider. Source.
  • Another study has found a decrease in psychopathology (i.e., symptoms of mental illness, such as depression or anxiety) when trans people transition. The biggest drop was just after starting hormone therapy. Source.
  • A study on the changes in sexual desire/activity in trans people was published. In a nutshell, sex drive went down for trans women with hormone therapy but recovered a bit after surgery (compared with those who wanted/planned surgery but hadn’t had it yet). In contrast, trans men generally had their sex drive go up with hormones/surgery. Source.
Oct 232013
 

This post is a legacy page, and was part of an on-going series, Trans 101 for Trans People. It covers questions about medical transition, hormones, surgeries, or seeking health care for transgender people.

For the material that once lived on this page, please see this page.

Please update your links to the full Trans 101.